Neo-Natal Anæsthesia

As the ages of the patients concerned may vary from a matter of hours to weeks, and, as feeding difficulties have usually rendered them underweight, it will be appreciated that these factors, when reinforced perhaps by vomiting and increased liability to respiratory infection, make anesthesia in infants one of the major problems to be faced in anaesthetic practice. When operation is not a matter of urgency, as for instance in harelip , then operation should, if possible, only be undertaken in mild weather, preferably during the summer months, when the incidence of respiratory infection is at its lowest level. With regard to pre-operative care, the babies should be nursed in a warm sunny cubicle, and, if possible, have a separate nursing staff. The chest, nose, throat, and ears are carefully checked, and any abnormal physical signs, such as a rise in temperature or naso.pharangeal infection are absolute contra-indications to operation, except in emergency cases. If dehydration is marked, an intravenous drip should be running. In this respect hyaluronidase has proved quite useful for hypodermoclysis. In connection with diet, if feeding is not impossible, due to the condition present, the baby continues with its normal diet until the last feed before operation. The last feed is diluted with an equal quantity of 10 per cent. glucose and only half of the usual quantity is given. An interval of two to three hours elapses before operation. A similar feed is given after operation. The glucose insures that the liver will be well bolstered against the toxic effects of the anaesthetic. In the cases of harelip the infants will, of course, have been treated for anaemia and brought up to weight by careful feeding. Premedication consists of atropine alone, as any respiratory depression is dangerous, the dose being 1-200th to 1-150th grain, depending Qn the size of the infant. With the bigger infants .07 gramme of sodium soneryl may be given if the infant is very restless. Where obstruction in the gut is present a small stomach tube should be in position. The safest anesthetic agent in neo-natal work appears to be ether, delivered with a liberal supply of oxygen. Ethyl chloride should never be used, as it is a potent cardio-respiratory depressant. The ether, when given with nitrous oxide and oxygen and followed by i per cent. novocaine infiltration of the abdominal wall gives, in our view, the best available anaesthetic, both …